Serum Total Testosterone Levels Pre- and Post-Subinguinal Microsurgical Varicocelectomy in Men with Clinical Varicoceles

Background: Varicocele is abnormal dilation and tortousity of the scrotal venous pampiniform plexus that drain blood from each testicle. Recently, it has been linked to low serum total testosterone (TT) levels by affecting the optimal functioning of the leydig cell via increasing the scrotal temperature. Varicocele repair has been found post-operatively to increase the serum levels of TT. This study looks at the pre and post-subinguinal microsurgical varicocelectomy serum TT levels in male patients with clinical varicocele. Methods: The study involved 88 male patients with clinical varicoceles who met the inclusion criteria. These patients after good history taking and physical examination had their serum TT levels measured pre varicocelectomy and 6 months post-subinguinal microsurgical varicocelectomy. The varicoceles were diagnosed by physical examination and use of scrotal color Doppler ultrasonography (US). Results: The number of patients with varicocele were 88 males. The mean age of the patients was 33.43 ± 7.82 years. There was isolated left varicocele in 57 (64.8%) patients and bilateral varicocele in 27 (30.7%) patients. Pre varicocelectomy, 61 (69.3%) patients had serum TT of between 100 - 290 nanogram/deciliter (ng/dl) and a mean value of 241 ± 0.91 ng/dl. Post varicocelectomy 56 (63.6%) patients had serum TT in the range of 300 - 490 ng/dl with a mean of 482 ± 2.87 ng/dl, showing a robust significant increase in the serum TT post-operatively (P < 0.001). Conclusion: There was statistically significant improvement in the serum TT levels with 55 (79%) patients exhibiting normalization of serum TT levels after subinguinal microsurgical varicocelectomy.

Testosterone level and mortality in elderly men wit systolic chronic heart failure

Previous studies on the prognostic significance of serum levels of androgens in patients with chronic heart failure （CHF） have yielded conflicting results. The aim of this study was to examine the relationship between serum concentration of testosterone and mortality in men with systolic CHF. A total of 175 elderly men （age ≥60 years） with CHF were recruited. Total testosterone （TI＇） and sex hormone-binding globulin （SHBG） were measured, and estimated free testosterone （eFT） was calculated. The median follow-up time was 3.46 years. Of these patients, 17 had a TT level below 8 nmol I^-1 （230 ng dI^-1）, 27 had an eFT level below 0.225 nmol I^-1 （65 pg ml^-1） and 12 had both. Using the age-specific tenth percentiles of TT and eFT in healthy men in our laboratory as cutoff points, the prevalences of TT and eFT deficiency was 21.7% （38/175） and 27.4% （48/175）, respectively. Both TT and eFT were inversely associated with left ventricular ejection fraction （LVEF） and N-terminal pro-brain natriuretic peptide （NT-pro-BNP） （all P〈0.01）. Kaplan-Meier curves for patients in low, medium and high tertiles according to TT and eFT level showed significantly different cumulative survival rate （both P〈0.01 by log-rank test）. However, after adjustment for clinical variables, there were no significant associations of either TT or eFT levels with survival time （0R=0.97, 95% CI： 0.84-1.12, P=0.28 and 0R=0.92, 95% CI： 0.82-1.06, P=0.14, respectively）. Our study showed that levels of TT and eFT are commonly decreased in elderly patients with systolic CHF and related to disease severity, but they are not independent predictors for mortality.

Prostate cancer volume associates with preoperative plasma levels of testosterone that independently predicts high grade tumours which show low densities(quotient testosterone/tumour volume)

Objective:To investigate potential associations of preoperative total testosterone(TT)with tumor volume(TV)and grade of prostate cancer(PCa).Methods:Patients who were under medications impacting on the hypothalamic-pituitaryadrenal-testis-prostate axis were excluded.TT was measured preoperatively at least 1 month after biopsies and TV was calculated on the removed prostate specimen.Other continuous variables included total prostate specific antigen(PSA),percentage of positive cores(Pt)and weight(W)of the removed prostate.Patients were categorized according to the pathologic Gleason score(pGS)in 3 groups(pGS 6,7 and>7).Invasion of the seminal vesicles was coded as seminal vesicle invasion(SVI).Results:The median levels of TT were significantly and increasingly higher from pGS 6(14.7 nmol/L)to pGS 7(15.0 nmol/L)and pGS>7(18.8 nmol/L).The median values of TV were also detected significantly and increasingly higher from pGS 6(5.6 mL)to pGS 7(8.1 mL)and pGS>7(14.8 mL).The median preoperative levels of PSA were also increasing from pGS 6(5.9 μg/L)to pGS 7(6.2 μg/L)and pGS>7(7.7 μg/L).There was a significant and positive correlation of TV to PSA,TT and Pt.Multiple linear regression analysis showed that TV was significantly and independently predicted by TT,PSA and Pt.High grade PCa(pGS>7)independently associated with TV,TT,Pt and SVI.The median density values of TT relative to TV(quotient TT/TV)significantly decreased from pGS 6(2.6 nmol/L/mL)to pGS 7(1.9 nmol/L/mL)and pGS>7(1.4 nmol/L/mL).The median density values of PSA relative to TV(quotient PSA/TV)also significantly decreased from pGS(1.1 μg/L/mL)to pGS 7(0.7 μg/L/mL)and pGS>7(0.6 μg/L/mL).Conclusion:The investigation shows that TT relates to volume and grade of PCa;moreover,the density of TT relative to TV inversely associates with rate of increase of cancer that depends on the grade of the tumour.

Low serum testosterone predicts upgrading and upstaging of prostate cancer after radical prostatectomy

Often, pathological Gleason Score （GS） and stage of prostate cancer （PCa） were inconsistent with biopsy GS and clinical stage.However, there were no widely accepted methods predicting upgrading and upstaging PCa. In our study, we investigated the association between serum testosterone and upgrading or upstaging of PCa after radical prostatectomy （RP）. We enrolled 167 patients with PCa with biopsy GS 〈6, clinical stage ≤T2c, and prostate-specific antigen （PSA） 〈10 ng ml-1 from April 2009 to April 2015. Data including age, body mass index, preoperative PSA level, comorbidity, clinical presentation, and preoperative serum total testosterone level were collected. Upgrading occurred in 62 （37.1%） patients, and upstaging occurred in 73 （43.7%） patients. Preoperative testosterone was lower in the upgrading than nonupgrading group （3.72 vs 4.56, P 〈 0.01）. Patients in the upstaging groUp had lower preoperative testosterone than those in the nonupstaging group （3.84 vs 4.57, P = 0.01）. In multivariate logistic regression analysis, as both continuous and categorical variables, low serum testosterone was confirmed to be an independent predictor of pathological upgrading （P = 0.01 and P = 0.01） and upstaging （P = 0.01 and P = 0.02） after RR We suggest that low serum testosterone （〈3 ng ml-1） is associated with a high rate of upgrading and upstaging after RP. It is better for surgeons to ensure close monitoring of PSA levels and imaging examination when selecting non-RP treatment, to be cautious in proceeding with nerve-sparing surgery, and to be enthusiastic in performing extended lymph node dissection when selecting RP treatment for patients with low serum testosterone.

Prevalence of late-onset hypogonadism among middle-aged and elderly males in China:results from a national survey

This study aimed to propose an operational definition of late-onset hypogonadism(LOH)that incorporates both clinical symptoms and serum testosterone measurements to evaluate the prevalence of LOH in aging males in China.A population-based sample of 6296 men aged 40 years-79 years old was enrolled from six representative provinces in China.Serum total testosterone(TT),sex hormone-binding globulin(SHBG),and luteinizing hormone(LH)were measured and free testosterone(cFT)was calculated.The Aging Males’Symptoms(AMS)scale was used to evaluate the LOH symptoms.Finally,5078 men were included in this analysis.The TT levels did not decrease with age(P=0.59),and had no relationship with AMS symptoms(P=0.87 for AMS total score,P=0.74 for≥3 sexual symptoms).The cFT levels decreased significantly with age(P<0.01)and showed a negative association with the presence of≥3 sexual symptoms(P=0.03).The overall estimated prevalence of LOH was 7.8%(395/5078)if a cFT level<210 pmol l−1 combined with the presence of≥3 sexual symptoms was used as the criterion of LOH.Among them,26.1%(103/395)and 73.9%(292/395)had primary and secondary hypogonadism,respectively.After adjustment for confounding factors,primary and secondary hypogonadism was positively related to age and comorbidities.Body mass index was an independent risk factor for secondary hypogonadism.The results suggest that the AMS total score is not an appropriate indicator for decreased testosterone,and that the cFT level is more reliable than TT for LOH diagnosis.Secondary hypogonadism is the most common form of LOH.